Cerebral haemorrhagic contusions are a type of intracerebral haemorrhage and are common in the setting of significant head injury.
Contusions, by definition, result from head trauma, and are thus seen more frequently in young males. Typical causes include motor vehicle accidents or situations in which the head strikes the pavement.
Most contusions represent the brain coming to a sudden stop against the inner surface of the skull (contrecoup) accentuated by the natural contours of the skull (see below).
- intraventricular haemorrhage in ~2.5% 7
Cerebral contusions can occur anywhere, but have a predilection for certain locations, as a result of the direction of head strike and the intrinsic shape of the skull cavity.
Typically cortical contusions become more apparent on follow up imaging due to further bleed or surrounding oedema, hence on follow up CT scans in first couple of days after trauma, one may detect increase in number and size of the lesions but patient may not show any clinical deterioration.
Furthermore the appearance of contusions will vary according to when they are imaged. Typically they mature over a number of weeks, initially appearing as merely haemorrhagic foci, followed by the development of surrounding oedema, before gradually fading away leaving behind more or less obvious areas of gliosis.
In most hospitals CT is usually the first and often only investigation used to assess cerebral contusions. Sensitivity to detect intracerebral haemorrhage on CT scans is virtually 100%.
Hounsfield units (HU) of blood are dependent of protein concentration (i.e. haemoglobin) and haematocrit.
With a haematocrit of 45% the density of whole blood is ~56 HU while grey matter is 37-41 HU and white matter is 30-34 HU. So blood should be hyperdense in comparison to grey or white matter.
Of note, in anaemic patients (i.e. haemoglobin < 8-10 g/dL) blood may appear isodense in an acute bleeding.
Contusions vary in size and can appear as small petechial foci of hyperdensity/haemorrhages involving the grey matter and subcortical white matter or large cortical/subcortical bleed.
Signal behaviour is strongly dependent on sequence and time since the bleeding started.
Practical pearls and pitfalls
- 1. Flint AC, Manley GT, Gean AD et-al. Post-operative expansion of hemorrhagic contusions after unilateral decompressive hemicraniectomy in severe traumatic brain injury. J. Neurotrauma. 2008;25 (5): 503-12. doi:10.1089/neu.2007.0442 - Pubmed citation
- 2. D'avella D, Cacciola F, Angileri FF et-al. Traumatic intracerebellar hemorrhagic contusions and hematomas. J Neurosurg Sci. 2001;45 (1): 29-37. - Pubmed citation
- 3. Hadley DM, Teasdale GM, Jenkins A et-al. Magnetic resonance imaging in acute head injury. Clin Radiol. 1988;39 (2): 131-9. Clin Radiol (link) - Pubmed citation
- 4. Kim J, Smith A, Hemphill JC et-al. Contrast extravasation on CT predicts mortality in primary intracerebral hemorrhage. AJNR Am J Neuroradiol. 2008;29 (3): 520-5. doi:10.3174/ajnr.A0859 - Pubmed citation
- 5. Parizel PM, Makkat S, Van miert E et-al. Intracranial hemorrhage: principles of CT and MRI interpretation. Eur Radiol. 2001;11 (9): 1770-83. Eur Radiol (link) - Pubmed citation
- 6. Wada R, Aviv RI, Fox AJ et-al. CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage. Stroke. 2007;38 (4): 1257-62. doi:10.1161/01.STR.0000259633.59404.f3 - Pubmed citation
- 7. Castillo M. Neuroradiology Companion: Methods, Guidelines, and Imaging Fundamentals. LWW. ISBN:1451111754. Read it at Google Books - Find it at Amazon
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Cerebral haemorrhagic contusions||✗|
|Haemorrhagic cerebral contusion||✗|
|Haemorrhagic cerebral contusions||✗|
|Intracerebral haemorrhagic contusions||✗|
|Haemorrhagic intracerebral contusion||✗|
|Cerebral hemorrhagic contusion||✗|
|Hemorrhagic cerebral contusion||✗|
|Hemorrhagic cerebral contusions||✗|